Basic Information
| Provider Information | |||||||||
| NPI: | 1639107568 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERNANDEZ | ||||||||
| FirstName: | EDUARDO | ||||||||
| MiddleName: | |||||||||
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| Credential: | L.AC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4715 NE 14TH AVE. | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9719983155 | ||||||||
| FaxNumber: | 5032821697 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 E 19TH ST | ||||||||
| Address2: | |||||||||
| City: | THE DALLES | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970583389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412967585 | ||||||||
| FaxNumber: | 5412967610 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | AC00255 | OR | Y | Other Service Providers | Acupuncturist |
No ID Information.